基于Markov模型对2种治疗高血压联合用药方案的药物经济学评价

Pharmacoeconomic Evaluation of Two Combined Regimens in the Treatment of Hypertension Based on Markov Model

关键词:  高血压  血管紧张素受体拮抗剂  钙通道阻滞剂  利尿剂  药物经济学

Key words:  hypertension  angiotensin receptor blocker  calcium channel blocker  diuretic  pharmacoeconomics

摘要:

目的 通过建立Markov模型，对血管紧张素受体拮抗剂（angiotensin receptor blockage，ARB）联合二氢吡啶类钙通道阻滞剂（calcium channel blockers，CCB）、ARB联合噻嗪类利尿剂2种治疗高血压方案进行药物经济学评价，为临床用药提供循证依据。方法 检索Medline及PubMed英文数据库，以“hypertension、calcium channel blockers、diuretics、angiotensin II receptor blocker、randomized controlled trial”及其对应的MeSH词为关键词进行检索。参考药品价格、治疗成本、健康效用值、状态转移概率建立Markov模型，对2种方案的有效性和经济学进行评价，并进行敏感性分析。结果 ARB+CCB组治疗高血压累计成本为32 780.34元，获得6.73质量调整生命年（quality-adjusted life years，QALYs）；ARB+利尿剂组治疗高血压累计成本为31 781.07元，获得6.81QALYs，相比于ARB+CCB组的增量成本效果比为-12 490.88元/QALYs。敏感性分析与原结果一致。结论 与ARB+CCB组相比，ARB+利尿剂组能获得更长的生存结果，其付出的增量成本–效果低于1倍人均GDP，更具有经济学效益。

Abstract:

OBJECTIVE To evaluate pharmacoeconomic programme of angiotensin receptor blocker(ARB) combined with dihydropyridine calcium channel blocker(CCB), ARB and thiazide diuretic to treat elderly hypertension by establishing Markov model and to provide evidence for clinical drug use. METHODS Search Medline and PubMed English database, the search terms were “hypertension, calcium channel blockers, diuretics, angiotensin II receptor blocker, randomized controlled trial” and their corresponding MeSH words. Established a Markov model with reference to drug prices, treatment costs, health utility values, and state transition probability, evaluated the effectiveness and economics of the two options, and performed sensitivity analysis. RESULTS The cumulative cost of treatment for hypertension in ARB+CCB group was 32 780.34 yuan, and 6.73 quality-adjusted life years(QALYs). The cumulative cost of treatment for hypertension in ARB+diuretic group was 31 781.07 yuan, which was 6.81 QALYs, compared with the increase of ARB+CCB group, the cost-effective ratio was –12 490.88 yuan/QALYs. Sensitivity analysis was consistent with the original results. CONCLUSION Compared with the ARB+CCB group, the ARB+diuretic group can achieve longer survival results, and the incremental cost‑effect is less than 1 times GDP per capita, which is more economical.